Skip to main content
    • Aa
    • Aa

Initial construction of a maladaptive personality trait model and inventory for DSM-5

  • R. F. Krueger (a1), J. Derringer (a1), K. E. Markon (a2), D. Watson (a3) and A. E. Skodol (a4)...

DSM-IV-TR suggests that clinicians should assess clinically relevant personality traits that do not necessarily constitute a formal personality disorder (PD), and should note these traits on Axis II, but DSM-IV-TR does not provide a trait model to guide the clinician. Our goal was to provide a provisional trait model and a preliminary corresponding assessment instrument, in our roles as members of the DSM-5 Personality and Personality Disorders Workgroup and workgroup advisors.


An initial list of specific traits and domains (broader groups of traits) was derived from DSM-5 literature reviews and workgroup deliberations, with a focus on capturing maladaptive personality characteristics deemed clinically salient, including those related to the criteria for DSM-IV-TR PDs. The model and instrument were then developed iteratively using data from community samples of treatment-seeking participants. The analytic approach relied on tools of modern psychometrics (e.g. item response theory models).


A total of 25 reliably measured core elements of personality description emerged that, together, delineate five broad domains of maladaptive personality variation: negative affect, detachment, antagonism, disinhibition, and psychoticism.


We developed a maladaptive personality trait model and corresponding instrument as a step on the path toward helping users of DSM-5 assess traits that may or may not constitute a formal PD. The inventory we developed is reprinted in its entirety in the Supplementary online material, with the goal of encouraging additional refinement and development by other investigators prior to the finalization of DSM-5. Continuing discussion should focus on various options for integrating personality traits into DSM-5.

Corresponding author
*Address for correspondence: R. F. Krueger, Ph.D., Department of Psychology, University of Minnesota, N414 Elliott Hall, Minneapolis, MN 55455, USA. (Email:
Hide All
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised, p. 685. American Psychiatric Association: Washington, DC.
AsparouhovT (2005). Sampling weights in latent variable modeling. Structural Equation Modeling 12, 411434.
AustinEJ, DearyIJ (2000). The ‘four As’: a common framework for normal and abnormal personality? Personality and Individual Differences 28, 977995.
BrowneMW (2001). An overview of analytic rotation in exploratory factor analysis. Multivariate Behavioral Research 36, 111150.
CaiL (2010). High-dimensional exploratory item factor analysis by a Metropolis–Hastings Robbins–Monro algorithm. Psychometrika 75, 3357.
CellaD, RileyW, StoneA, RothrockN, ReeveB, YountS, AmtmannD, BodeR, BuysseDJ, ChoiSW, CookKF, DeVellisR, DeWaltD, FriesJF, GershonR, HahnE, PilkonisP, RevickiD, RoseM, WeinfurtK, HaysRD, on behalf of the PROMIS Cooperative Group (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology 63, 11791194.
ChmielewskiM, WatsonD (2008). The heterogeneous structure of schizotypal personality disorder: item-level factors of the schizotypal personality questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality. Journal of Abnormal Psychology 117, 364376.
ClarkLA (2007). Assessment and diagnosis of personality disorder: perennial issues and emerging conceptualization. Annual Review of Psychology 58, 227258.
ClarkLA, SimmsLJ, WuKD, CasillasA (in press). Manual for the Schedule for Nonadaptive and Adaptive Personality – Second Edition (SNAP-2). University of Minnesota Press: Minneapolis, MN.
CostaPTJr., McCraeRR (1992). Revised NEO Personality Inventory NEO–PI–R and NEO Five-Factor Inventory NEO–FFI Professional Manual. Psychological Assessment Resources: Odessa, FL.
CostaPTJr., WidigerTA (editors) (2002). Personality Disorders and the Five-Factor Model of Personality, 2nd edn. American Psychological Association: Washington, DC.
CuijpersP, SmitF, PenninxBWJH, de GraafR, ten HaveM, BeekmanATF (2010). Economic costs of neuroticism: a population-based study. Archives of General Psychiatry 67, 10861093.
De ClercqB, De FruytF, Van LeeuwenK, MervieldeI (2006). The structure of maladaptive personality traits in childhood: a step toward an integrative developmental perspective for DSM-5. Journal of Abnormal Psychology 115, 639657.
de MoorMHM, CostaPT, TerraccianoA, KruegerRF, de GeusEJC, ToshikoT, PenninxBW, EskoT, MaddenPA, DerringerJ, AminN, WillemsenG, HottengaJJ, DistelMA, UdaM, SannaS, SpinhovenP, HartmanCA, SullivanP, RealoA, AllikJ, HeathAC, PergadiaML, AgrawalA, LinP, GruczaR, NutileT, CiulloM, RujescuD, GieglingI, KonteB, WidenE, CousminerDL, ErikssonJG, PalotieA, PeltonenL, LucianoM, TenesaA, DaviesG, LopezLM, HansellNK, MedlandSE, FerrucciL, SchlessingerD, MontgomeryGW, WrightMJ, AulchenkoYS, JanssensAC, OostraBA, MetspaluA, AbecasisGR, DearyIJ, RäikkönenK, BierutLJ, MartinNG, van DuijnCM, BoomsmaDI (2010). Meta-analysis of genome-wide association studies for personality. Molecular Psychiatry. Published online: 21 December 2010. doi:10.1038/mp.2010.128.
DennisJM (2010). Summary of Knowledge Panel Design ( Accessed 11 November 2011.
EmbretsonSE, ReiseSP (2000). Item Response Theory for Psychologists. Lawrence Erlbaum Associates, Inc.: Mahwah, NJ.
GoldbergLR (1993). The structure of phenotypic personality traits. American Psychologist 48, 2634.
HarknessAR, LilienfeldSO (1997). Individual differences science for treatment planning: personality traits. Psychological Assessment 9, 349360.
HarknessAR, McNultyJL, Ben-PorathYS (1995). The personality psychopathology five (PSY-5): constructs and MMPI-2 scales. Psychological Assessment 7, 104114.
HopwoodCJ, DonnellanMB (2010). How should the internal structure of personality inventories be evaluated? Personality and Social Psychology Review 14, 332346.
HopwoodCJ, QuigleyBD, MoreyLC, BenderDS, SkodolAE, StoutRL, McGlashanTH, GriloCM, GundersonJG (2008). Personality traits and mental health treatment utilization. Personality and Mental Health 2, 207217.
KendlerKS, AggenSH, KnudsenGP, RøysambE, NealeMC, Reichborn-KjennerudT (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. American Journal of Psychiatry 168, 2939.
KraemerHC, KupferDJ, NarrowWE, ClarkeDE, RegierDA (2010). Moving toward DSM-5: the field trials. American Journal of Psychiatry 167, 11581160.
KruegerRF, EatonNR (2010). Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology. Personality Disorders: Theory, Research, and Treatment 1, 97–118.
LivesleyWJ (2007). A framework for integrating dimensional and categorical classifications of personality disorder. Journal of Personality Disorders 21, 199224.
LivesleyWJ, JacksonDN (2009). Manual for the Dimensional Assessment of Personality Pathology. Sigma Press: Port Huron, MI.
MarkonKE (2010). Modeling psychopathology structure: a symptom-level analysis of axis I and II disorders. Psychological Medicine 40, 273288.
MarkonKE, KruegerRF, WatsonD (2005). Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. Journal of Personality and Social Psychology 88, 139157.
MoreyLC (2003). Essentials of PAI Assessment. John Wiley: New York.
MuthénLK, MuthénBO (1998–2010). MPlus Users Guide, 6th edn. Muthén & Muthén: Los Angeles, CA.
NestadtG, CostaPTJr., HsuF-C, SamuelsJ, BienvenuOJ, EatonWW (2008). The relationship between the five-factor model and latent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder dimensions. Comprehensive Psychiatry 49, 98–105.
OltmannsTF, TurkheimerE (2009). Person perception and personality pathology. Current Directions in Psychological Science 18, 3236.
PiedmontRL, ShermanMF, ShermanNC, Dy-LiaccoGS, WilliamsJE (2009). Using the five-factor model to identify a new personality disorder domain: the case for experiential permeability. Journal of Personality and Social Psychology 96, 12451258.
PincusAL, LukowitskyMR, WrightAGC (2010). The interpersonal nexus of personality and psychopathology. In Contemporary Directions in Psychopathology: Scientific Foundations for DSM-V and ICD-11 (ed. MillonT., KruegerR. and SimonsenE.), pp. 523552. Guilford: New York.
RøysambE, KendlerKS, TambsK, OrstavikRE, NealeMC, AggenSH, TorgersenS, Reichborn-KjennerudT (2011). The joint structure of DSM-IV axis I and axis II disorders. Journal of Abnormal Psychology 120, 198209.
SamuelDB, WidigerTA (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: a facet level analysis. Clinical Psychology Review 28, 13261342.
SchwarzGE (1978). Estimating the dimension of a model. Annals of Statistics 6, 461464.
Scientific Software International, Inc. (2010). IRTPRO Application, version 1.1.20215.1 BETA ( Accessed August 2010.
SimmsL, GoldbergLR, RobertsJE, WatsonD, WelteJ, RottermanJH (2011). Computerized Adaptive Assessment of Personality Disorder: introducing the CAT-PD project. Journal of Personality Assessment 93, 380389.
SimmsL, WatsonD (2007). The construct validation approach to personality scale construction. In Handbook of Research Methods in Personality Psychology (ed. RobinsR. W., FraleyR. C. and KruegerR. F.), pp. 240258. Guilford: New York.
SmitsN, VorstHCM (2007). Reducing the length of questionnaires through structurally incomplete designs: an illustration. Learning and Individual Differences 17, 2534.
TangTZ, DeRubeisRJ, HollonSD, AmsterdamJ, SheltonR, SchaletB (2009). Personality change during depression treatment: a placebo-controlled trial. Archives of General Psychiatry 66, 13221330.
TeamRDC (2010). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna.
TrullTJ, DurrettCA (2005). Categorical and dimensional models of personality disorder. Annual Review of Clinical Psychology 1, 355380.
van den OordEJCG (2005). Estimating Johnson curve population distributions in MULTILOG. Applied Psychological Measurement 29, 4564.
van den OordEJCG, KuoP-H, HartmannAM, WebbBT, MollerH-J, HettemaJM, GieglingI, BukszárJ, RujescuD (2008). Genomewide association analysis followed by a replication study implicates a novel candidate gene for neuroticism. Archives of General Psychiatry 65, 10621071.
WatsonD, ClarkLA, ChmielewskiM (2008). Structures of personality and their relevance to psychopathology: II. Further articulation of a comprehensive unified trait structure. Journal of Personality 76, 15451586.
WidigerTA, LivesleyWJ, ClarkLA (2009). An integrative dimensional classification of personality disorder. Psychological Assessment 21, 243255.
WidigerTA, SimonsenE (2005). Alternative dimensional models of personality disorder: finding a common ground. Journal of Personality Disorders 19, 110130.
ZwickWF, VelicerWF (1986). Comparison of five rules for determining the number of components to retain. Psychological Bulletin 99, 432442.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Krueger Supplementary Material
Krueger Supplementary Material

 Word (1.6 MB)
1.6 MB


Altmetric attention score

Full text views

Total number of HTML views: 84
Total number of PDF views: 588 *
Loading metrics...

Abstract views

Total abstract views: 1924 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th October 2017. This data will be updated every 24 hours.